ADA Complaint Form HomeADA CoordinatorADA Complaint Form Items marked with an asterisk(*) are required. Your Information Name* (First, Middle Initial, and Last) Home Phone* Business Phone Email Address Person Denied Disability Access Skip this section if you are filing this complaint for yourself. Name* (First, Middle Initial, and Last) Home Phone* Business Phone Email Address State Agency Accused of Denying Disability Access Agency*—Please choose an option—Apple CommissionArts CommissionAthletic CommissionBarley CommissionBean CommissionBoard of Tax AppealsBoise State UniversityCode CommissionCommission for the Blind & Visually ImpairedCommission of Pardons and ParoleCommission on AgingCommission on Hispanic AffairsCorrectional IndustriesCouncil for Deaf and Hard of HearingCouncil on Developmental DisabilitiesCouncil on Domestic ViolenceDairy CommissionDepartment of AdministrationDepartment of AgricultureDepartment of CorrectionDepartment of EducationDepartment of Environmental QualityDepartment of FinanceDepartment of Fish and GameDepartment of Health and WelfareDepartment of InsuranceDepartment of LandsDepartment of Parks and RecreationDepartment of Water ResourcesDivision of Financial ManagementDivision of Human ResourcesDivision of MilitaryDivision of Occupational & Professional LicensesDivision of Veterans ServicesDivision of Vocational RehabilitationEducational Services for the Deaf and the BlindEndowment Fund Investment BoardForest Products CommissionGrape Growers & Wine Producers CommissionHouse of RepresentativesIdaho Board of Scaling PracticesIdaho Career and Technical EducationIdaho Children’s Trust FundIdaho Commission for LibrariesIdaho Department of CommerceIdaho Department of Juvenile CorrectionsIdaho Department of LaborIdaho Department of TransportationIdaho Industrial CommissionIdaho Public Safety CommunicationsIdaho Public TelevisionIdaho Rural PartnershipIdaho Soil and Water Conservation CommissionIdaho State Historical SocietyIdaho State Liquor DivisionIdaho State PoliceIdaho State UniversityIdaho Supreme CourtIdaho Tax CommissionIdaho Workforce Development CouncilInformation Technology ServicesJudicialLava Hot Springs FoundationLegislative Services OfficeLewis-Clark State CollegeLottery CommissionNorthwest Power and Conservation CouncilOffice of Drug PolicyOffice of Energy and Mineral ResourcesOffice of Performance EvaluationsOffice of Secretary of StateOffice of Species ConservationOffice of the Attorney GeneralOffice of the GovernorOffice of the Lieutenant GovernorOffice of the State Board of EducationOffice of the State ControllerOffice of the State TreasurerPea and Lentil CommissionPotato CommissionPublic Employee Retirement System of IdahoPublic Health District 1Public Health District 2Public Health District 3Public Health District 4Public Health District 5Public Health District 6Public Health District 7Public Utilities CommissionRangeland Resource CommissionSenateState Appellate Public DefenderState Independent Living CouncilState Insurance FundState Public Defense CommissionSTEMSuperintendent of Public InstructionUniversity of IdahoWheat Commission Department (if applicable) Agency Address Phone Number Email Incident Details Date of incident* (YYYY-MM-DD format) Describe the denial of disability access or discrimination providing the name(s) where possible of the individuals who discriminated:* Have efforts been made to resolve this complaint through the internal grievance procedure of the State Agency:*YesNo If yes, what is the status of the grievance?: Has the complaint been filed with another bureau of the Department of Justice or any other Federal, State, or local civil rights agency or court?*YesNo If yes: Agency or Court Contact Person Address Phone Number Date Filed Witness Information If applicable. Name (First, Middle Initial, and Last) Home Phone Business Phone Email Address May we contact this witness?YesNo Complaint Acknowledgement By clicking submit, you certify the information provided is accurate to the best of your knowledge. You understand and consent to the disclosure of information contained in this complaint.
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